The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

Jupiter Medical Center at The Calcagnini Center for Mindfulness
1210 S. Old Dixie Highway, Jupiter, Florida 33458, Suite M-117.2


 


 (561) 263-MIND (6463); option #2 or (561) 510-3833
 
Executive Office: 1116 Jackpine St. Wellington, Florida 33414                                                                                                                                                                     

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Male Impotence

Definition

Today, the term impotence has largely been supplanted by the less pejorative erectile dysfunction (ED). It is defined as the inability to attain or sustain an erection satisfactory for intercourse. In the U.S. alone, an estimated 20 million men aged >18 are affected, but its prevalence increases with age and most men who experience it are aged 40-75. Normally men can enjoy sexual activity well into the 70's and 80's and erectile dysfunction is neither inevitable nor normal.

Only approximately 5% of ED is primary--where a man has never been able to attain or sustain an erection. This is almost always due to psychological factors (guilt, sexual trauma, severe anxiety, depression, or intimacy issues). Over 90% of ED is secondary--when a man who had previously normal function no longer can attain or sustain an erection. Secondary ED is almost always organic in nature. The overwhelming majority of these cases have a vascular cause. Other causes include hormonal imbalance, neurologic disorder, or medications. Even transient episodes of ED can create secondary psychological problems which complicate the problem. These possible psychological factors that may accompany an organic disorder cannot be dismissed and must be addressed in every case.

Vascular Factors. The two conditions which can result in ED are atherosclerotic disease of the penile arteries and venous leakage. The former reduces the amount of blood entering the penis and the latter makes it difficult for blood to remain in the penis during erection. Diabetes, smoking, and hypertension are associated with atherosclerosis and increased incidence of ED.

Hormonal Factors. Believe it or not, the link between low testosterone and ED is not definite. Low serum level of free testosterone is clearly a cause of decreased libido, however. ED can be caused by hypothyroidism, hyperthyroidism, elevated prolactin, or elevated cortisol.

Neurologic Factors. Rare and usually obvious, these factors include stroke, multiple sclerosis, autonomic dysfunction, spinal cord injuries, certain forms of seizure disorders, and previous prostate surgery.

Medications. Over 25% of ED is caused by prescription drugs. These include blood pressure medications, beta blockers, diuretics, antidepressants, chemotherapies, sedatives, heart medications, and so many others.

Diagnosis includes inquiries about medications, atherosclerosis, hypertension, smoking, diabetes, heart disease, circulatory conditions, and psychological issues. A general examination is mandatory including examination of the genitalia, pulses, dhatus, srotas, and assessment of ojas and agni. Lab tests can include: sperm count and motility testing, serum glucose, thyroid function tests, and serum testosterone (total and free). Sometimes luteinizing hormone, FSH, and prolactin levels are also recommended. I have not found specialized tests like nocturnal penile tuminescence to be at all helpful.

It is of note that ED is observed to occur simultaneously with one or more of the following secondary signs or symptoms. Because the reproductive tissues (shukra dhatu) are intimately connected to and affected by the other six bodily tissues which form it, ED is referred to in Ayurveda as dhatukshaya, or "loss of tissues." Hence a number of seemingly unrelated conditions can appear: forgetfulness, memory loss, dull intellect, insecurity, loss of confidence, indecisiveness, irrational fears, edema, burning sensations in parts of the body, muscle flaccidity, inability to gain or retain muscle mass, craving for sweets, reduced immune function, sallow complexion.

Treatment

Simple preparations

  • Brahmi leaf powder 1-3 grams with water 3X daily
  • Equal parts of brahmi, vidari, and yastimadhu, 1-3 grams with 1 tsp honey and cow's milk 3X daily
  • Equal parts of decorticated Kapikacchu seed powder, ashwagandha powder, shatavari powder with 100 ml. cow's milk and 25 grams of jaggery 3X daily
  • Amalaki powder or tablets 1-2 grams with 1 teaspoon ghee 3X daily
  • Mix four parts ashwagandha powder, two parts shilajit powder, one part gokshura powder, 3-6 grams with cow's milk 2X daily

Compound preparations

  • Brhat vata chintamani 125 mg with jaggery (raw sugar) 2X daily
  • Trailokya rasa chintamani 125 mg with jaggery (raw sugar) 2X daily
  • Makaradhvaja 1 tablet with honey 2X daily
  • Ashwagandharista 1 tablespoon with equal water 3X daily
  • Brahmi ghrita 1 tablespoon with 100 ml. cow's milk and a pinch of pippali powder 2X daily

Dietary recommendations

Often: Basmati rice, wheat, mung dal, milk, butter, ghee, hen's eggs, swan's eggs, meat and soup of chicken, deer, rabbit, mutton, grapes, dates, mango, figs, pomegranate, powdered sesame seeds.

Seldom: chillies, pickles, pungent and very sour foods.

Massage oils

  • Narayana taila
  • Mahanarayana taila
  • Guduchyadi taila
  • Chandanbala laxadi taila
  • Bala taila

In some cases, Ayurvedic acupuncture treatments (suchi chikitsa) can be effective as adjunctive therapy but only with a truly experienced vaidya who is trained specifically in this specialty.